Family Therapy E-Book

Alan Carr

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: Wiley Series in Clinical Psychology
• Sprache: Englisch

Seitenzahl: 1024

Veröffentlichungsjahr: 2012

Beschreibung

Now in its third edition, this highly regarded and well-established textbook includes up-to-date coverage of recent advances in family therapy practice and reviews of latest research, whilst retaining the popular structure and chapter features of previous editions.

• Presents a unique, integrative approach to the theory and practice of family therapy
• Distinctive style addresses family behaviour patterns, family belief systems and narratives, and broader contextual factors in problem formation and resolution
• Shows how the model can be applied to address issues of childhood and adolescence (e.g. conduct problems, drug abuse) and of adulthood (e.g. marital distress, anxiety, depression)
• Student-friendly features: chapters begin with a chapter plan and conclude with a summary of key points; theoretical chapters include a glossary of new terms; case studies and further reading suggestions are included throughout

Leseprobe

Contents

ABOUT THE AUTHOR

FOREWORD TO THE THIRD EDITION

PREFACE

ACKNOWLEDGEMENTS

Part One CENTRAL CONCEPTS IN FAMILY THERAPY

Chapter 1 GOALS OF FAMILY THERAPY ACROSS THE LIFECYCLE

THE FAMILY LIFECYCLE

LIFECYCLE STAGES ASSOCIATED WITH SEPARATION AND DIVORCE

THE INDIVIDUAL LIFECYCLE

GENDER-ROLE DEVELOPMENT

GAY AND LESBIAN LIFECYCLES

CLASS, CREED AND COLOUR

CONCLUSION

Chapter 2 ORIGINS OF FAMILY THERAPY

MOVEMENTS: CHILD GUIDANCE, MARRIAGE COUNSELLING AND SEX THERAPY

DISCIPLINES: SOCIAL WORK, PSYCHIATRY AND CLINICAL PSYCHOLOGY

GROUP THERAPY: GROUP ANALYSIS, ENCOUNTER GROUPS, PSYCHODRAMA AND GESTALT THERAPY

RESEARCH TRADITIONS: WORK GROUPS, ROLE THEORY AND SCHIZOPHRENIA

GREGORY BATESON

THREE ORGANISING THEMES: BEHAVIOUR PATTERNS, BELIEFS AND CONTEXTS

CONCLUSION

GLOSSARY

Chapter 3 THEORIES THAT FOCUS ON BEHAVIOUR PATTERNS

MRI BRIEF THERAPY

STRATEGIC FAMILY THERAPY

STRUCTURAL FAMILY THERAPY

COGNITIVE-BEHAVIOURAL COUPLE AND FAMILY THERAPY

FUNCTIONAL FAMILY THERAPY

CONCLUSION

GLOSSARY

Chapter 4 THEORIES THAT FOCUS ON BELIEF SYSTEMS

EPISTEMOLOGY: POSITIVISM, CONSTRUCTIVISM, SOCIAL-CONSTRUCTIONISM, MODERNISM AND POSTMODERNISM

A CONSTRUCTIVIST APPROACH TO FAMILY THERAPY

MILAN SYSTEMIC FAMILY THERAPY

SOCIAL-CONSTRUCTIONIST DEVELOPMENTS

SOLUTION-FOCUSED THERAPY

NARRATIVE THERAPY

CONCLUSION

GLOSSARY

Chapter 5 THEORIES THAT FOCUS ON CONTEXTS

TRANSGENERATIONAL FAMILY THERAPY

PSYCHOANALYTIC FAMILY THERAPY

ATTACHMENT-BASED THERAPIES

EXPERIENTIAL FAMILY THERAPY

MULTISYSTEMIC FAMILY THERAPY

PSYCHOEDUCATIONAL FAMILY THERAPY

CONCLUSION

GLOSSARY

Chapter 6 INTEGRATIVE MODELS

METAFRAMEWORKS

INTEGRATIVE PROBLEM-CENTRED THERAPY

INTEGRATIVE PROBLEM-CENTRED METAFRAMEWORKS

ATTACHMENT NARRATIVE THERAPY

INTEGRATIVE COUPLE THERAPY

AFFECTIVE-RECONSTRUCTIVE COUPLE THERAPY

INTEGRATIVE APPLICATIONS WITHIN SPECIFIC PROFESSIONS

CONCLUSION

GLOSSARY

Part Two PROCESSES IN FAMILY THERAPY

Chapter 7 THE STAGES OF FAMILY THERAPY

STAGE 1. PLANNING

STAGE 2. ASSESSMENT

STAGE 3. TREATMENT

STAGE 4. DISENGAGING OR RECONTRACTING

CONCLUSION

Chapter 8 FORMULATING PROBLEMS AND EXCEPTIONS

THE THREE-COLUMN PROBLEM-FORMULATION MODEL

THE THREE-COLUMN EXCEPTION-FORMULATION MODEL

QUESTIONS TO ASK WHEN CONSTRUCTING THREE-COLUMN FORMULATIONS

RECURSIVE REFORMULATION

CONCLUSION

Chapter 9 INTERVENTIONS FOR BEHAVIOUR, BELIEFS AND CONTEXTS

CRITERIA FOR SELECTING INTERVENTIONS

BEHAVIOUR-FOCUSED INTERVENTIONS

INTERVENTIONS FOCUSING ON BELIEF SYSTEMS

INTERVENTIONS FOCUSING ON HISTORICAL, CONTEXTUAL AND CONSTITUTIONAL FACTORS

CONCLUSION

Part Three FAMILY THERAPY PRACTICE WITH CHILD- AND ADOLESCENT-FOCUSED PROBLEMS

Chapter 10 CONDUCT PROBLEMS

SYSTEMIC MODEL OF CONDUCT PROBLEMS

FAMILY THERAPY FOR CONDUCT PROBLEMS

CONCLUSION

Chapter 11 DRUG MISUSE IN ADOLESCENCE

SYSTEMIC MODEL OF DRUG MISUSE IN ADOLESCENCE

FAMILY THERAPY FOR DRUG MISUSE IN ADOLESCENCE

CONCLUSION

Part Four FAMILY THERAPY PRACTICE WITH ADULT-FOCUSED PROBLEMS

Chapter 12 DISTRESSED COUPLES

SYSTEMIC MODEL OF DISTRESSING INTIMATE RELATIONSHIPS

COUPLE THERAPY

CONCLUSION

Chapter 13 DEPRESSION AND ANXIETY

DEPRESSION

ANXIETY

SYSTEMIC MODEL OF DEPRESSION AND ANXIETY

COUPLE THERAPY FOR DEPRESSION AND ANXIETY

CONCLUSION

Part Five RESEARCH AND RESOURCES

Chapter 14 EVIDENCE-BASED PRACTICE IN COUPLE AND FAMILY THERAPY

OVERALL EFFECTIVENESS AND COST-EFFECTIVENESS OF SYSTEMIC THERAPY

CHILD-FOCUSED PROBLEMS

ADULT-FOCUSED PROBLEMS

COMMON FACTORS

CONCLUSION

GLOSSARY

Chapter 15 PROFESSIONAL RESOURCES

WRITTEN COMMUNICATION

TRAINING EXERCISES

CONCLUSION

REFERENCES

INDEX

Praise for the third edition

“Alan Carr’s book is a masterpiece in the family therapy field. Its major strength is its comprehensive and fluent presentation of both the conceptual and practice frameworks for working with families in a concise and integrated manner. An excellent textbook for students, as well as an ideal reference for new and experienced practitioners.”

Dr. John Sharry, Founding Director, Parents Plus Charity, Principal Social Worker, Mater Child and Adolescent Mental Health Service, Republic of Ireland

“This eagerly awaited third edition of Alan Carr’s Family Therapy: Concepts, Process and Practice more than lives up to its respected predecessors. This magisterial text is actually several books in one. It organises the whole field of family therapy through his famous three columns of behaviour, beliefs and context, which eventually become the basis for detailed accounts of formulations and interventions fully illustrated with role plays, sample questions and follow-up readings. Alan Carr has done an enormous service to family therapy by providing a coherent and convincing account of its rationales and evidence, while using his great experience in training to give us the means to continue to progress.”

Peter Stratton, Emeritus Professor of Family Therapy, University of Leeds, UK

”The third edition of Alan Carr’s book provides a comprehensive overview of the family therapy field in a way that will appeal to everyone from novice toexperienced practitioner. Carr has the unique ability of combining a sympathetic account of a range of different theories and conceptual ideas from different authors with a very distinctive voice of his own, offering a pragmatic, integrative approach to clinical practice with families which has a great appeal. As always he supplements this with detailed reviews of existing research with indications of how this should be used to inform the clinician. I strongly recommend this book for all whether they want to use it to read from cover to cover or just as an incredibly well resourced reference book.”

Ivan Eisler, Professor of Family Psychology and Family Therapy, Institute of Psychiatry, King’s College London, UK

“Rarely does one find a text that breaks new ground. This is an extraordinary volume that provides a clear, practical, and conceptually sound review of the core models and approaches in family therapy. It is grounded in science, sound theory, and attention to the core conceptual principles of each approach. What is unique is that Alan Carr goes well beyond the material reviewed to add something new—a rare accomplishment for such a book. His formulation model brings together the unique and often different perspectives of theory, science, and practice in a way that actually gives the reader a ‘map’ to follow in the practice of family therapy. This volume is a ‘gem’ that will bring a new perspective to those in training and practice.”

Thomas L. Sexton, Professor and Director, Center for Adolescent and Family Studies, Indiana University

Wiley Series in

CLINICAL PSYCHOLOGY

    Adrian Wells         School of Psychological Sciences,

(Series Advisor)         University of Manchester, UK

For other titles in this series please visit www.wiley.com/go/cs

This edition first published 2012© 2012 John Wiley & Sons, Ltd.

Wiley-Blackwell is an imprint of John Wiley & Sons, formed by the merger of Wiley’s global Scientific, Technical and Medical business with Blackwell Publishing.

Registered OfficeJohn Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK

Editorial Offices350 Main Street, Malden, MA 02148-5020, USA9600 Garsington Road, Oxford, OX4 2DQ, UKThe Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK

For details of our global editorial offices, for customer services, and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell.

The right of Alan Carr to be identified as the author of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold on the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought.

Library of Congress Cataloging-in-Publication Data

Carr, Alan, Dr.Family therapy : concepts, process, and practice / Alan Carr. – 3rd ed.p. ; cm.Includes bibliographical references and index.

ISBN 978-1-119-95464-4 (hb) – ISBN 978-1-119-95465-1 (pbk.)[DNLM: 1. Family Therapy. WM 430.5.F2]616.89′156–dc23

2012018057

A catalogue record for this book is available from the British Library.

Cover image © Anna Subbotina / ShutterstockCover design by Design Deluxe

ABOUT THE AUTHOR

Professor Alan Carr is the director of the doctoral training programme in clinical psychology at University College Dublin and Consultant Couple and Family Therapist at the Clanwilliam Institute in Dublin. He has ­published over 20 books and 200 academic papers and conference presentations in the fields of family therapy and clinical psychology. His work has been translated into a number of languages, including Korean, Polish and Chinese. He has extensive experience in family therapy and clinical psychology, having worked in the field in the UK, Ireland and Canada.

FOREWORD TO THE THIRD EDITION

‘I have said it twice: That alone should encourage the crew… I have said it thrice: What I tell you three times is true.’

Lewis Carroll, The Hunting of the Snark

Just a few weeks ago, I received an email from a family therapist unknown to me who lived in Great Britain. She had written because she had an idea for what appeared to be a very exciting project on assessing the outcomes of family therapy and was hoping to resume her postgraduate studies with a research focus on this project, but seemingly was unclear about how to pursue such a goal. I responded to her without hesitation that ­certainly there could be no one in all of Great Britain and Ireland who would know more about such matters than Alan Carr. Indeed, I do believe that there can be no one in Ireland and Great Britain and few people in most other places in the world who know as much about family therapy as Alan Carr. He is one of those rare members of our community who has both profound and always up-to-date knowledge of all that is happening in the field, whether it involves theory development, clinical practice or advances in research methodology. And an uncanny aptitude for putting all that down on paper in a way that is unwaveringly clear and digestible.

And so, having enthusiastically written the Foreword for the first two editions of this wonderful book, I now am more certain than ever that ‘What I tell you three times is true’: Family Therapy: Concepts, Process and Practice is, to quote myself, no mere introductory textbook but rather ‘a pedagogical goldmine’ and a ‘singular contribution’ to the field of ­couple and family therapy. Teachers of family therapy owe Alan Carr a very large ‘Thank you’ for having crisply and cogently set forth an accounting of all the major approaches to the field. Carr apologises for what he says may be an ‘oversimplification’ of these models. But I dis­agree with this self-assessment. Mere simplification requires both depth and breadth of knowledge. Carr certainly has that. But what he refers to too humbly as ‘over’-simplification, in my view, requires an even greater capacity, the capacity to convey essences. He has that as well. And another essential element of this third edition that teachers of family ­therapy also should be thankful for is his having paid much more ­attention to clinical work with couples than the very large majority of family ­therapy textbooks, thereby reflecting the real-world practice of family therapy far better than most.

As I said in earlier editions of Family Therapy, Carr’s second ‘book within a book’, his widely respected ‘Formulation Model’ of clinical problems and exceptions to clinical problems, itself provides sufficient warrant for reading this text and assigning it to students. For both groups, the Formulation Model provides a comprehensive and rational template for organising case formulations that are flexible and responsive to differences both between families and between clinicians. That is, there are many ways to activate healing mechanisms in the practice of couple and family therapy, and Carr’s model offers a solid foundation for responsible integrative clinical practice that ‘works’ for client and therapist alike. Family Therapy: Concepts, Process and Practice is simply a gem of a book.

Alan S. Gurman, PhDClinical Professor of PsychologyTeaching Faculty, The Family Institute at Northwestern UniversityEvanston, Illinois, USASenior Preceptor, Clinical Psychology Doctoral ProgramUniversity of Wisconsin-MadisonMadison, Wisconsin, USA

PREFACE

‘One beginning and one ending for a book was a thing I did not agree with. A good book may have three openings entirely dissimilar and inter-related only in the prescience of the author, or for that matter one hundred times as many endings … One book, one opening, was a principle with which I did not find it possible to concur.’

Flann O’Brien, At Swim-Two-Birds

‘The end lies concealed in the beginning. All bodies grow around a skeleton. Life is a petticoat about death. I will not go to bed.’

James Stephens, The Crock of Gold

‘New worlds for old.’

James Joyce, Ulysses

This new edition of Family Therapy: Concepts, Process and Practice retains the same overall structure, style and content as the first and second ­editions but includes a number of important revisions that make it more useful for postgraduates, trainers and experienced therapists:

The content and references in each chapter have been updated to take account of significant developments that have occurred in the past 5 years.

Developments in the formulation model have been added to Part Two.

Parts Three and Four have been revised in light of relevant new theoretical and empirical material on each of the child- and adult-focused problems addressed in these sections.

The research review in Chapter 14 has been brought up to date.

The book retains all of the features of the earlier editions which have made it popular among postgraduates and experienced clinicians alike. The book has also been shortened to make it more compact and affordable by dropping chapters on some child- and adult-focused problems and ­editing the final chapter on resources.

Family Therapy: Concepts, Process and Practice was written both as a textbook for use in marital and family therapy professional postgraduate training programmes and as a sourcebook for experienced clinicians. The book offers a critical evaluation of the major schools of family therapy, an integrative model for the practice of couple and family therapy, and ­examples of how this model may be used with a range of common child- and adult-focused problems. Findings from research on the effectiveness of family therapy are reviewed and the implications of these for evidence-based practice are outlined.

Part One contains a critical evaluation of the major schools of family therapy. The major traditions are grouped together in terms of their ­central focus of therapeutic concern, and in particular with respect to their emphasis on: (1) problem-maintaining behaviour patterns; (2) problem-related belief systems and narratives; and (3) historical, contextual and constitutional predisposing factors.

Family therapy schools which highlight the role of repetitive patterns of family interaction in the maintenance of problem behaviour and advocate practices which aim to disrupt these patterns of interaction include the MRI brief therapy approach, strategic therapy, structural therapy, cognitive-behavioural approaches and functional family therapy.

Traditions that point to the centrality of belief systems and narratives which subserve repetitive interaction patterns include constructivism, Milan systemic family therapy, social-constructionist family therapy approaches, solution-focused therapy and narrative therapy.

Traditions which highlight the role of historical, contextual and constitutional factors in predisposing family members to adopt particular belief systems and engage in particular problematic interaction patterns include transgenerational family therapy, psychoanalytic family therapy traditions, attachment theory-based approaches, experiential family therapy, multisystemic therapy and psychoeducational approaches.

This organisation of schools of therapy in terms of their emphases on three particular themes is a useful learning device, but an oversimplification. Most schools of family therapy address problem-maintaining behaviour patterns, constraining beliefs and broader historical, contextual and constitutional factors. However, the classification of schools according to the degree to which they emphasise these three themes offers a backdrop against which a number of integrative models are presented, including the integrative approach to family therapy advocated in this volume.

A three-column model for formulating both problems and exceptions to these is presented in Part Two of this book. The formulation model uses the three themes by which the schools of family therapy were classified to organise information about a particular problem. That is, it is argued that for any problem, a formulation may be constructed using ideas from many schools of family therapy in which the pattern of family interaction which maintains the problem is specified, the constraining beliefs and narratives which underpin each family member’s role in this pattern are outlined and the historical, contextual and constitutional factors that underpin these belief systems and narratives are specified. In parallel with this, a similar formulation may be constructed to explain why the problem does not occur in exceptional circumstances, which while similar to problematic situations, differ in important key respects.

In light of these formulations, a range of interventions which address factors within each column of these three-column formulations may be considered. Some interventions aim primarily to disrupt problem-­maintaining behaviour patterns or amplify exceptional nonproblematic patterns. Others aim to help family members reauthor their constraining narratives and develop more liberating and flexible belief systems which underpin exceptions to the problem. Still others aim to modify the negative impact of historical, contextual and constitutional factors or to draw on family strengths in these domains. Thus, while it is accepted that the classification of schools of family therapy according to three themes is an oversimplification, it is a particularly useful oversimplification insofar as it may facilitate a coherent, integrative and flexible approach to the ­practice of family therapy.

In Part Three the way the integrative model can be used in the treatment of common child-focused problems, including conduct problems and drug abuse, is outlined. The application of the model with common adult-focused problems is considered in Part Four. The focus here is on marital distress, depression and anxiety.

In Part Five, evidence for the effectiveness of family therapy and family-based interventions with a range of and child- and adult-focused ­problems is addressed and the implications of this research for evidence-based ­practice are set out. Also, useful training resources are presented.

While this volume is intended as a sourcebook for experienced ­clinicians, it has also been written as a textbook for newcomers to the field of family therapy and systemic consultation. I have probably erred on the side of oversimplifying many complex ideas in an attempt to make the family therapy literature accessible to the newcomer. I hope that experienced ­clinicians can bear with this shortcoming. A glossary of new terms and reading lists are provided at the end of theoretical chapters.

The integrative model and approach to practice described here evolved in two particular contexts. The groundwork for the model was laid in the 1980s and early 1990s while working in a UK National Health Service Child and Family Clinic (Carr, 1995, 1997). During this period there was a national emphasis on cooperation between health service professionals and their colleagues in social services and education. There was also an emphasis on liaison between district hospital departments offering ­services to children such as child psychology, child psychiatry and ­paediatrics. In addition, many hospitals within the NHS became privately run trusts. These factors created a climate which favoured the development of models of assessment and intervention that were time-limited, that took account of the wider professional network of which the child and therapist were part, that clearly addressed the overlap between the roles of therapist and agent of social control and that could be evaluated or audited in a relatively objective way. The model was then extended for use with adult-focused problems at the Clanwilliam Institute in Dublin.

Many of us who work in the field of systemic consultation and family therapy at some time during our professional development have held the view that there is a true formulation of the client’s problems and exceptions to these and a related correct set of solutions. In the approach described in the heart of this book, it is assumed that the formulations which emerge from talking with families about their presenting problem and exceptions to this are no more than social constructions. Since it is possible to ­construct multiple formulations to explain any problem or exception, it is important to have a criterion by which to judge the merit of any particular one.

In the approach to practice presented in the heart of this volume, it is the usefulness of formulations in suggesting a variety of feasible solutions that are acceptable to the family which is the sole criterion for judging the merit of one formulation over another. Because of its emphasis on the socially constructed nature of problem and exception formulations and the choice of usefulness as a criterion for selecting between different ­formulations, the approach described in this volume may be viewed as falling within the tradition of social constructionism.

In deciding about the usefulness of formulations and interventions, ­clinicians using the approach to practice set out in this volume are invited to take account of the results of empirical research on the efficacy and ­effectiveness of family therapy. Indeed, an overview of systemic ­therapy outcome research is given in Chapter 14. Because of the social-constructionist positioning that is taken in this book and because ­treatment-outcome research results are used to inform clinical practice, this text will be of interest to both postmodern practitioners and ­­empirically orientated clinicians.

Alan CarrUniversity College Dublin and Clanwilliam Institute DublinMay 2012

ACKNOWLEDGEMENTS

I am grateful to the many colleagues, friends and relatives who have helped me develop the ideas presented in this book. In particular, I would like to thank the group who introduced me to family therapy at the Mater Hospital in Dublin in the late 1970s: Dr Imelda McCarthy, Professor Jim Sheehan, Dr Nollaig Byrne, Koos Mandos and Dr Paul McQuaid.

I am also grateful to Dr Chris Cooper, Peter Simms and Carol Elisabeth Burra in Kingston, Ontario, with whom I worked while living in Canada.

In the UK my gratitude goes to the group with whom I practiced at Thurlow House and the Queen Elizabeth Hospital in King’s Lynn ­during the 1980s and early 1990s: Dr Dermot McDonnell, Dr Chris Wood, George Gawlinski, Shiela Docking, Sue Grant, Nick Irving, Shahin Afnan, Dr Jonathan Dossetor, Dr Dennis Barter, Denise Sherwood and Mike Cliffe.

Thanks are due to Mark Rivett, Professor Ivan Eisler, Dr Eddy Street, Professor John Carpenter, Bebe Speed and Professor Bryan Lask at the ­editorial office of the Journal of Family Therapy; to Professor Terry Trepper, editor of the Journal of Family Psychotherapy; to Professor Peter Stratton, editor of Human Systems: The Journal of Systemic Consultation and Management; to Max Cornwall, editor of The Australian Journal of Family Therapy; to Professor Doug Sprenkle, past editor of the Journal of Marital and Family Therapy; and to Professor Michael Nichols, former editor of Contemporary Family Therapy, for challenging me to articulate my ideas more clearly. I am grateful to Professor Martin Herbert at Exeter University and Professor Arlene Vetere at the University of Surrey for their collegial support.

Thanks to Mike Coombs, Senior Publishing Editor with John Wiley & Sons Press for guidance throughout the production of the first edition of this book, to Deborah Egleton for her support with the production of the second edition, and to Darren Reed, Commissioning Editor, for his ­support during the production of the third edition.

Past and present colleagues at UCD, especially Professor Ciarán Benson, Dr Gary O’Reilly, Dr Muireann McNulty, Dr Barbara Dooley, Muriel Keegan, Dr Suzanne Guerin, Dr Jessica Bramham, Dr Jennifer Edgeworth, Professor Patricia Noonan Walsh, Fíona Kelly Meldon and Frances Osborne, have been very supportive of my efforts to write the three editions of this book and I am grateful to them for their patience and encouragement.

A special word of thanks is due to past and present colleagues at the Clanwilliam Institute in Dublin, particularly Dr Ed McHale, Phil Kearney, Aileen Tiernery, Dr Bernadette O’Sullivan, Declan Roche, Clive Garland, Cory deJong, Innes Collins, Noreen Dennehy, Breda McGee, Linda Finnegan, Dr Gregor Lange, Carl Murphy, Adele McGrath, Ray O’Sullivan, Mary Callanan, Valerie Downes, Aaron Pollock, Geraldine Cahill and Michelle McCafferty.

Postgraduates at UCD and the Clanwilliam have offered useful feedback which has been helpful in writing this book and I am grateful to them for this.

Much of what I know about family life, I have learned from my own family, and to them I owe a particular debt of gratitude.

Go raibh míle maith agaibh go léir.

Alan CarrUniversity College Dublin and Clanwilliam Institute DublinJanuary 2012

Part One

CENTRAL CONCEPTS IN FAMILY THERAPY

Chapter 1

GOALS OF FAMILY THERAPY ACROSS THE LIFECYCLE

Family therapy is a broad term for a range of methods for working with families with various biopsychosocial difficulties. Within the broad ­cathedral of family therapy there is a wide variety of views on what types of problems are appropriately addressed by family therapy; who defines these problems; what constitutes family therapy practices; what type of theoretical rationale underpins these practices; and what type of research supports the validity of these practices.

Some family therapists argue that all human problems are essentially relational and so family therapy is appropriate in all instances. Others argue that marital and family therapy are appropriate for specific relationship problems or as an adjunct to pharmacological treatment of particular conditions such as schizophrenia.

Some family therapists argue that problems addressed in therapy are defined by clients. That is, parents, children or marital partners seeking help. Others argue that problems are best defined by professionals in terms of psychiatric diagnoses or statutory status, such as being a family in which child abuse has occurred and which is on an at-risk register, or being a person with an alcohol problem on probation.

With respect to practices, some family therapists invite all family ­members to all therapy sessions. Others conduct family therapy with individuals, by empowering them to manage their relationships with family members in more satisfactory ways. Still others have broadened family therapy so that it includes members of the wider professional and social network around the family; they may refer to this approach as systemic practice.

There are many theories of family therapy. Some focus on the role of the family in predisposing people to developing problems or in precipitating their difficulties. Others focus on the role of the family in problem maintenance. But all family therapists highlight the role of the family in problem resolution. There is also considerable variability in the degree to which theories privilege the role of family patterns of interaction, family belief systems and narratives, and historical contextual and constitutional ­factors in the aetiology and maintenance of problems.

With respect to research, some family therapists argue that case studies or descriptive qualitative research provide adequate support for the ­efficacy of family therapy. On the other hand, some family therapists ­highlight the importance of quantitative results from controlled research trials in supporting the degree to which family therapy is effective in ­treating specific problems.

Within this volume an integrative and developmental approach will be taken to family therapy, and where better to start than with a consideration of family problems across the lifecycle?

Family problems occur across all stages of the lifecycle. Here are some examples:

A 6-year-old whose parents cannot control him and who pushes his sister down the stairs.

A 13-year-old girl who worries her parents because she will not eat and has lost a lot of weight.

A 19-year-old boy who believes he is being poisoned and refuses to take prescribed antipsychotic medication.

A couple in their mid-thirties who consistently argue and fight with each other.

A blended family in which the parents have both previously been married and have difficulties managing their children’s unpredictable and confusing behaviour.

A family in which a parent has died prematurely and in which the 13-year-old has run away from home.

A family in which a child is terminally ill and will not follow medical advice.

A family with traditional values in which a teenager ‘comes out’ and declares that he is gay.

A family in which both parents are unemployed and have difficulty managing their children without getting into violent rows.

A black family living in a predominantly white community, where the 16-year-old boy is involved in drug abuse in a delinquent peer group.

These are all complex cases which involve or affect all family members to a greater or lesser degree. A number of these cases also involve or affect members of the community in which the family lives. In some of the cases listed, other agencies including schools, hospitals, social services, law enforcement, juvenile justice or probation may be involved. Family ­therapy is a broad psychotherapeutic movement which offers conceptual frameworks for making sense of complex cases such as those listed here and entails approaches to clinical practice for helping families resolve complex problems.